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Volume 54, Issue 12
Displaying 1-12 of 12 articles from this issue
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Keiji HANADA, Tomohiro IIBOSHI, Kentaro YAMAO, Naomichi HIRANO2012 Volume 54 Issue 12 Pages 3773-3782
Published: 2012
Released on J-STAGE: January 18, 2013
JOURNAL FREE ACCESSDetection of pancreatic cancer (PC) at an early stage with curative surgery is the approach with the potential to significantly improve the patient's long-term outcome. Previously, after the first US examination, computed tomography (CT) was mainly performed in cases with dilatation of the main pancreatic duct, or in the presence of a cystic lesion. However, the rate of tumor detection of CT in the case of small pancreatic cancer lesions was unsatisfactory. For the diagnosis of PC lesions less than 10 mm, the rate of tumor detection was higher for endoscopic ultrasound (EUS) than for CT or other modalities, and the histologic diagnosis with EUS- fine needle aspiration (FNA) was helpful in confirming the diagnosis. For the diagnosis of PC in situ, EUS and magnetic resonance cholangiopancreatography (MRCP) played important roles in detecting the local irregular stenosis of the pancreatic duct. Endoscopic retrograde cholangiopancreatography (ERCP) and sequential cytodiagnosis of pancreatic juice using endoscopic nasopancreatic drainage (ENPD) multiple times have been useful in the diagnosis of PC in situ. In the future, the relationship between specialized doctors for PC in medical centers and practicing doctors would be very important to establish a social program for the early diagnosis of PC in a rural doctor's association.View full abstractDownload PDF (1393K)
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Atsushi IMAGAWA, Keiko TAKEUCHI, Yasunari YOSHIDA, Taiko ANZAI, Hideki ...2012 Volume 54 Issue 12 Pages 3783-3789
Published: 2012
Released on J-STAGE: January 18, 2013
JOURNAL FREE ACCESSAlthough hyoscine butyl bromide and glucagon are often used as antispasmodic drugs during esophagogastroduodenoscopy, these agents may cause adverse effects. Recently, it was reported that peppermint oil solution (PO) was very effective and had few side effects. We clarified the effectiveness and safety of PO as an antispasmodic for ESD that is a time-consuming and complex endoscopic treatment. The antispasmodic scores, frequency of other additional drugs, the sustained antispasmodic time and adverse events associated with PO were evaluated. The average of the antispasmodic score in a total of 165 ESD procedures was 4.66 (1 to 5, where 5 represent no spasm). One-point-nine percent of all cases required additional antispasmodic agents, and the average of the sustained time was 44.8 min. There was no severe adverse event for PO during ESD procedures. In conclusion, PO was useful and safe as an antispasmodic during ESD.View full abstractDownload PDF (1031K)
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Fumiaki KAWANO, Ryou SEKIYA, Kunihide NAKAMURA, Toshio ONITSUKA2012 Volume 54 Issue 12 Pages 3790-3796
Published: 2012
Released on J-STAGE: January 18, 2013
JOURNAL FREE ACCESSWe report herein on a case of esophageal carcinosarcoma hanging down into the stomach. A 67-year-old man was referred to our hospital for investigation of a gastric lesion. A barium esophagogastrogram showed a huge elevated lesion in the cardiac portion. Endoscopic examination showed a nodular spherical tumor with coarse mucosa and partial furring, with a blood clot. It was not visible in the root of the tumor, but esophageal mucosa prolapse into the stomach was recognized. The lesion was diagnosed as a poorly differentiated carcinoma by endoscopic biopsy. We diagnosed it as gastric cancer and had planned a total gastrectomy. Intraoperative findings, however, revealed that the root of the tumor was located within the esophagus, so our diagnosis was esophageal cancer (suspected carcinosarcoma). We performed a partial esophagectomy and proximal gastrectomy. The surgical specimen showed that the pedunculated tumor existing in the stomach had arisen from the esophageal mucosa at 1 cm orally from the esophago-gastric junction. The histological findings produced a diagnosis of carcinosarcoma of the esophagus. We believed that the tumor had grown within the esophagus and dropped down into the stomach with as its weight and volume increased. This patient was a very rare case. Endoscopic findings are important for preoperative diagnosis of esophageal carcinosarcoma.View full abstractDownload PDF (1295K) -
Toshihiro KIHARA, Hiroki SUHARA, Yuuhei ICHIKAWA, Hideomi TOMIDA, Akih ...2012 Volume 54 Issue 12 Pages 3797-3803
Published: 2012
Released on J-STAGE: January 18, 2013
JOURNAL FREE ACCESSWe experienced a case of primary squamous cell carcinoma of the stomach. A 67-year-old man was admitted with epigastralgia. Endoscopic findings showed an ulcerative lesion on the lesser curvature of the gastric antrum. The tumor was diagnosed as squamous cell carcinoma from a biopsied specimen. An 18F-fluorodeoxyglucose positron emission tomography / computed tomography (FDG-PET/CT) study showed high FDG accumulation in the antrum of the stomach, and showed no malignancy at other sites. A distal gastrectomy with regional lymph nodes dissection was performed. Histopathological examination disclosed moderately or poorly differentiated squamous cell carcinoma without an adenocarcinoma component in all sections, and showed normal gastric mucosa between the squamous cell carcinoma of the stomach and the esophagus. Primary squamous cell carcinoma of the stomach is very rare. Only 45 cases, including our case, have been reported in Japan.View full abstractDownload PDF (1041K) -
Hidenori HARUTA, Yoshinori HOSOYA, Kentaro KURASHINA, Toru ZUIKI, Taka ...2012 Volume 54 Issue 12 Pages 3804-3811
Published: 2012
Released on J-STAGE: January 18, 2013
JOURNAL FREE ACCESSA 65-year-old man with gastric cancer and renal cell carcinoma underwent total gastrectomy with a Roux-en Y reconstruction and left nephrectomy. Two years postoperatively, the patient developed septic shock due to afferent loop syndrome caused by adhesions near the nephrectomy site. His afferent loop symptoms worsened over time, and his general condition deteriorated prior to admission. We performed a direct percutaneous endoscopic duodenostomy (D-PED) using double-balloon endoscopy (DBE) to drain the dilated afferent limb and simultaneously feed the patient via the efferent limb using a double lumen gastro-jejunostomy tube. His overall condition improved after the D-PED, and he underwent a duodeno-jejunal bypass three months later. DBE is feasible even at the duodenal stump after a Roux-en-Y reconstruction. This is the first report of a D-PED with DBE.View full abstractDownload PDF (1052K) -
Makoto FURIHATA, Hideyuki KUBO, Yuko ISHIBASHI, Tomoya MIZUNO, Jyun YA ...2012 Volume 54 Issue 12 Pages 3812-3817
Published: 2012
Released on J-STAGE: January 18, 2013
JOURNAL FREE ACCESSA 40-year-old woman presented with abrupt onset of large volume hematochezia and was admitted to our hospital. She had no significant medical history and had been quite well. An emergency colonoscopy revealed a small ulceration of about 7 mm with a pulsatile visible vessel located near the dentate line. We judged this ulceration to be the cause of the bleeding. The patient continued to have more significant bleeding and went into shock, so we needed to take a reliable measure to stop the bleeding. W decided it was better to suture by the transanal route under lumbar anesthesia than by endoscopic hemostasis because the size of the pulsatile visible vessel was inadequate for endoscopic management. No further bleeding occurred with a follow-up of 3 months after the operation. The case presented herein is a patient with an acute hemorrhagic rectal ulcer (AHRU) who had no underlying basic disease. It is important to evaluate the backgrounds of more patients affected with AHRU to clarify the pathophysiology.View full abstractDownload PDF (861K) -
Wataru IZUMO, Kenji HURUKAWA, Kieko YAMAZAKI, Kenichirou HATAJI, Akio ...2012 Volume 54 Issue 12 Pages 3818-3825
Published: 2012
Released on J-STAGE: January 18, 2013
JOURNAL FREE ACCESSA 75-year-old man with bowel obstruction was admitted to our hospital for further investigation. Colonoscopy and radiographic contrast enema showed advanced rectal carcinoma with near-circumferential stenosis and a diverticulum of the oral-side intestine. A trans-anal decompression tube was inserted as a single anastomotic operation after reducing the intestinal pressure, but the patient developed fever and abdominal pain 4 days later. Computed tomography revealed perforation by the trans-anal decompression tube. We performed Hartmann's operation, and exposed the tube 15 cm orally from the rectal carcinoma. There have previously been case reports of perforations caused by a trans-anal decompression tube, but the circumstances of our case are very rare.View full abstractDownload PDF (1032K)
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[in Japanese], [in Japanese], [in Japanese]2012 Volume 54 Issue 12 Pages 3826-3827
Published: 2012
Released on J-STAGE: January 18, 2013
JOURNAL FREE ACCESSDownload PDF (914K)
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Hiroshi KASHIDA, Fuyuhiko YAMAMURA, Kunihiko WAKAMURA2012 Volume 54 Issue 12 Pages 3828-3836
Published: 2012
Released on J-STAGE: January 18, 2013
JOURNAL FREE ACCESSThe endoscopic mucosal resection (EMR) or endoscopic piecemeal mucosal resection (EPMR) techniques using snares are still important as one of the treatment methods for colorectal neoplasms even after the advent of the endoscopic submucosal dissection (ESD) technique which employs special knives. Most early colorectal neoplasms can be treated with the EMR or EPMR technique. However, the indications for the ESD technique are fairly limited. The procedure time is shorter and the perforation rate is much lower for EPMR than for ESD. On the other hand, the postoperative bleeding rate is slightly higher and the local recurrence rate is much higher with the former. Recurrent lesions can usually be treated endoscopically when they are encountered. However, a careful and complete resection during the first procedure is most important.View full abstractDownload PDF (1586K)
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Yousuke NAKAI, Hiroyuki ISAYAMA, Osamu TOGAWA, Hirofumi KOGURE, Takesh ...2012 Volume 54 Issue 12 Pages 3837-3845
Published: 2012
Released on J-STAGE: January 18, 2013
JOURNAL FREE ACCESSAim : We previously reported a low occlusion rate with covered Wallstents for malignant biliary obstruction, but stent-related complications other than occlusion posed a problem. A modified covered Wallstent insertion method based on stent characteristics was evaluated to reduce stent-related complications.
Methods : A total of 138 patients with distal malignant biliary obstruction received covered Wallstent placement. From October 2001 to October 2003, 69 patients received covered Wallstent placement (Group 1). Thereafter, we modified our stent insertion method and 69 patients received stent placement using this modified method from November 2003 to January 2007 (Group 2). The modified insertion method consists of endoscopic sphincterotomy carried out in patients without pancreatic duct invasion and longer stent placement with the center of the stent located in the center of the biliary stricture to prevent pancreatitis, kinking of the bile duct, and stent dislocation. A comparative analysis was carried out using prospectively collected data in these two cohorts.
Results : Tumor ingrowth was not observed, and stent occlusion rate was 18.8% in Group 1 and 23.2% in Group 2. The overall rates of stent-related complications did not differ (39.1% in Group 1 and 30.4% in Group 2), but stent-related complications within 3 months decreased from 22 episodes in Group 1 to 13 episodes in Group 2. Median event-free survival was prolonged by modified stent insertion method (125 days in Group 1 and 268 days in Group 2, P=0.020), although cumulative survival and stent patency were not significantly different.
Conclusions : Our modified method of covered Wallstent placement showed improved event-free survival.View full abstractDownload PDF (750K)
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[in Japanese]2012 Volume 54 Issue 12 Pages 3846-3849
Published: 2012
Released on J-STAGE: January 18, 2013
JOURNAL FREE ACCESSDownload PDF (605K)
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[in Japanese]2012 Volume 54 Issue 12 Pages 3850
Published: 2012
Released on J-STAGE: January 18, 2013
JOURNAL FREE ACCESSDownload PDF (485K)
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